C H A P T E R 1 8
Vaccines and sera
287
Contraindications and cautions
Immune sera are contraindicated in individuals with
a history of severe reaction to any immune sera or to
products similar to the components of the sera
to
prevent potential serious hypersensitivity reactions.
They should be used with caution during pregnancy
because of potential risk to the fetus
; with coagulation
defects or thrombocytopenia; or in individuals with
a known history of previous exposure to the immune
sera
because increased risk of hypersensitivity reaction
occurs with each use.
Adverse effects
Adverse effects can be attributed either to the effect
of immune sera on the immune system (rash, nausea,
vomiting, chills, fever) or to allergic reactions (chest
tightness, falling blood pressure, difficulty breathing).
Local reactions, such as swelling, tenderness, pain or
muscle stiffness at the injection site, are very common.
Clinically important drug–drug interactions
Caution should be used if these drugs are combined
with any immune suppressant drugs, including cortico
steroids. These can alter the body’s response to the
biologicals.
TABLE 18.2
DRUGS IN FOCUS Immune sera (continued)
Drug name
Dosage/route
Usual indications
Antitoxins and antivenins (continued)
stonefish antivenom
(generic)
2000–6000 U IM or IV depending on number
of punctures
Systemic envenoming following bite from
stonefish, with severe oedema and pain
not responsive to first aid
taipan antivenom (generic)
12,000 U by slow IV diluted in Hartmann’s
solution
Systemic envenoming following bite from
taipan
tiger snake antivenom
(generic)
3000 U by slow IV diluted in Hartmann’s
solution
Systemic envenoming following bite from
tiger, copper head or black snake
Prototype summary: Immunoglobulin, normal
(human)
Indications:
Prophylaxis against hepatitis A, measles,
varicella, rubella; prophylaxis for people with
immunoglobulin deficiency.
Actions:
Provides preformed antibodies to
hepatitis A, measles, varicella, rubella and perhaps
other antigens, providing a passive, short-term
immunity.
Pharmacokinetics:
Route
Onset
Peak
IM
Slow
2–5 days
T
1/2
:
Unknown; metabolised in the tissues, excretion
is unknown.
Adverse effects:
Tenderness, muscle stiffness at site
of the injection; urticaria, angio-oedema, nausea,
vomiting, chills, fever, chest tightness.
Care considerations for
people receiving immune sera
Assessment: History and examination
■
■
Assess for contraindications or cautions: any
known allergies to any of these drugs or their
components
to prevent hypersensitivity reactions
;
current status related to pregnancy,
which would
be a contraindication for immune sera
; previous
exposure to the serum being used
because
hypersensitivity reactions become worse with
repeated exposure
; evidence of thrombocytopenia
or coagulation disorders,
which could be
exacerbated by the effects of immune sera
; and
immunisation history
to determine the potential
for hypersensitivity reactions
.
■
■
Perform a physical assessment
to determine
baseline status before beginning therapy and
for any potential adverse effects
: Inspect for
the presence of any skin lesions
to monitor for
hypersensitivity reactions
; check temperature
to monitor for possible infection
; monitor pulse,
respirations and blood pressure; auscultate
lungs for adventitious sounds; and assess
level of orientation and affect
to monitor for
hypersensitivity reactions to the vaccine
.
Implementation with rationale
■
■
Do not administer to any individual with a history
of severe reaction to immune globulins or to the
components of the drug being used
because severe
immune reactions can occur
.
■
■
Administer the drug as indicated.
Preparation
varies with each product; always check the
manufacturer’s guidelines
.
